A Pilates and Rehabilitation case study
Carrie arrived at physio with a painful, weak, right hip joint. She had noticed pain increasing over a period of intense workload at the end of her uni dance degree. The hip had been clicking a lot during some dance movements for quite a while. Ballet exercises, ‘rhonde de jambe en aire a la seconde’ and retire were especially painful now.
Physio testing of the hip showed:
Muscle control for pelvic stability on the single leg standing leg was poor, with Carrie ‘sitting’ into the hip in retire.
Carrie’s sub conscious de fault standing posture was what physios and Pilates instructors call ‘sway back’ posture, meaning she hangs her pelvis forward with the ribcage hanging back, and the knee joints hyperextended. This pushes the top of the thigh bone (head of femur) forward. This can put excessive pressure on the front hip muscles and joint structures.
Hip Impingement test: This involves flexing Carrie’s hip up and slightly inwards. This causes a pinching pain in the groin area, showing a consequence of a forward hip posture.
The area around Carrie’s lower spine and pelvic area was tight and painful, with many muscles activating in a protective compensatory mode around the hip.
Anyone heard of ‘Quadratus Femoris’ muscle?! It’s one of the main turn out muscles at the back of the hip.
Physio treatment aims to calm the inflamed hip tissues and solve the underlying postural and muscle activation issues. My treatment follows guidelines from the Australian Ballet’s wonderful hip exercise rehab programme, that has been developed over the years by the brilliant work of Sue Mayes, Aussie ballet physio and Paula Baird-Colt, exercise rehab and Pilates instructor.
Pilates based exercise rehab commences when acute pain has settled. Pilates focuses on ‘core’ muscle control with release of excessive back and hip muscle tension patterns. Exercises are kept ‘closed chain’ meaning many traditional
Pilates exercises are not taught without modification. The leg is supported and the heel is in contact with a ball or reformer footbar at first.
Carrie is gradually graded back from a modified dance class, with less turn out at first and lower leg position, to full dance class load. Hips do take a while to settle, but Carrie can prevent flaring the pain up, with her knowledge of how to manage the hip, as well as improving her dance specific technique, strength and control.
Her focus is to maintain the ‘hip in the centre of the pelvic socket’. This actually helps increase hip turn out range eventually and focuses on correct muscle function for turnout on standing leg and on gesture leg elevation.